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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404307
Report Date: 09/30/2022
Date Signed: 09/30/2022 04:04:15 PM

Document Has Been Signed on 09/30/2022 04:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CASA DI MIR MONTESSORI ELEMENTARY SCHOOLFACILITY NUMBER:
434404307
ADMINISTRATOR:SUNITA AUSTINFACILITY TYPE:
850
ADDRESS:90 EAST LATIMER AVENUETELEPHONE:
(408) 370-3073
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 60TOTAL ENROLLED CHILDREN: 53CENSUS: 14DATE:
09/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Joy YapTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced case management visit today and met with Director, Joy Yap. Today's visit is for the continuation of the case management visit from 9/21/2022 in regards to the clearance status for a staff (S1).

During today's visit, LPA confirmed with Director that until S1 has obtained background clearance, S1 will not be allowed in the areas in the preschool that are licensed under CCLD, nor is allowed to interact with preschool children, be part of the preschool staff ratio in class, nor is allowed to give breaks to preschool teachers. Per Director, this have been communicated with S1 and S1 has obliged with the policy.

Per Diretor, S1 will continue to support the elementary program only since S1 is a staff with the private school.


No deficiencies cited. Exit interview conducted and report was reviewed and a copy of this report was provided to Director.


A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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